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Severe headache: 6 common causes (and what to do)


Severe headache is usually caused by stress, migraine or sinusitis, but it can also indicate a hypertensive crisis, stroke and brain tumors in the most serious cases.

Depending on its cause, a severe headache may be accompanied by other symptoms such as nausea, vomiting, changes in vision, mental confusion, drowsiness, fever, nasal obstruction and yellowish phlegm.

In case of a severe headache, it is recommended to consult a neurologist, especially if the pain is frequent. However, if symptoms such as mental confusion, drowsiness, high blood pressure or weakness in parts of the body appear, it is recommended to go to an emergency room for evaluation.

What could be your severe headache

To find out what could be causing your severe headache, please answer the following questions:

This tool only serves as a means of guidance and, therefore, should not replace a consultation with a doctor, who is the most appropriate professional to confirm the diagnosis and recommend appropriate treatment.

What can a severe headache be?

The main causes of headache are:

1. Stress

Stress can sometimes cause a severe headache, due to excessive contraction of muscles in the neck and/or head, which is known as tension headache. Understand better what tension headache is and the symptoms.

However, the pain is usually not accompanied by other symptoms and is not intense enough to prevent the person from carrying out their daily tasks, only causing a feeling of tightness or pressure in the head.

What to do: The headache tends to go away within a few hours as the person relaxes. However, if the pain is very strong or frequent, it is recommended to consult a neurologist and treatment may involve medications, such as paracetamol, ibuprofen or amitriptyline, and psychotherapy.

2. Migraine

Migraines can cause a very severe headache in some people, which tends to affect only one side of the head and be accompanied by other symptoms such as nausea, vomiting and intolerance to noise and/or light.

When the headache is severe, the person may not be able to carry out their daily tasks and any movement of the head can worsen the discomfort, making them prefer to rest, especially in a quiet and dark place. Know the main symptoms of migraine.

What to do: If you suspect a migraine, it is important to consult a neurologist. Treatment may involve analgesic medications to relieve headaches and anticonvulsants to prevent seizures, for example.

In addition, changes in habits are recommended, such as getting enough sleep and always at the same times, avoiding going without food for a long time and practicing physical exercise regularly, to avoid crises. See treatment options for migraines.

3. Sinusitis

A severe headache can be caused by sinusitis, especially in cases where the inflammation in the cavities of the facial bones is more intense. It is also common for other symptoms to appear, such as fever, a feeling of pressure in the face, nasal obstruction and yellowish phlegm. Learn more sinusitis symptoms.

What to do: It is recommended to consult an otorhinolaryngologist if sinusitis is suspected. Treatment may involve the use of antipyretics, analgesics, antibiotics, nasal corticosteroids, decongestants and nasal washing, according to the doctor's instructions.

4. Hypertensive crisis

A severe headache may arise due to a large increase in blood pressure, which may be indicative of a hypertensive crisis, and especially when the pain is very intense, it may be a sign of greater severity.

Furthermore, the hypertensive crisis can also cause symptoms such as convulsive crisis, mental confusion, irritability and/or drowsiness and vision changes in the most severe cases. Check out other symptoms of hypertensive crisis.

What to do: Blood pressure should be measured to check whether it is significantly altered. Especially if the pressure is above 180 x 110 mmHg, it is recommended to seek emergency care, and the use of antihypertensives may be indicated to lower the pressure.

Furthermore, it is important to consult a cardiologist within the next few days for an evaluation and check the need to use antihypertensives daily or make adjustments to the doses of medications already used.

5. AVC

A cerebrovascular accident (CVA) can cause a very strong and sudden headache. In addition, the person may also experience nausea, vomiting, difficulty speaking and/or moving parts of the body and, in the most serious cases, loss of consciousness. Know the main symptoms of stroke.

What to do: It is recommended to seek an emergency room if you suspect a stroke. Treatment may involve medications to restore blood circulation to the brain, blood pressure control and surgery in the most serious cases, and should be started as soon as possible.

6. Tumor cerebral

Although it is rare, a severe headache can also be caused by brain tumors, and other symptoms such as weakness in parts of the body, drowsiness or irritability, seizures, vomiting and/or changes in vision are also common. Know the main symptoms of brain tumor.

What to do: It is recommended to consult a neurologist for a detailed evaluation when a brain tumor is suspected. When the diagnosis is confirmed, the headache tends to improve with treatment of the tumor, which may involve surgery and chemotherapy. See the main treatment options for brain tumors.

Which doctor to consult

In case of a severe headache, it is recommended to consult a neurologist, who is the best doctor to begin evaluating this symptom and rule out serious illnesses such as brain tumors.

If you want to make an appointment, you can find the neurologist closest to you using the tool below:

Depending on the changes found in the examination, the neurologist may refer the person to other specialists, such as a cardiologist or otorhinolaryngologist, to confirm the diagnosis and initiate the most appropriate treatment.